Which drugs are involved in metabolization?
In Meulengracht’s disease, the function of UDP-glucuronyltransferase is limited. Since the enzyme is important for the excretion of bilirubin as well as for the breakdown of other drugs, the disease can alter the effect of drugs and lead to undesired interactions. The drugs that are broken down by UDP-glucuronyltransferase include various HIV drugs (indinavir or atazanavir), cholesterol-lowering drugs (atorvastatin and simvastatin) and painkillers containing the active ingredients ibuprofen and paracetamol.
The active ingredient ibuprofen is broken down in the liver by UDP-glucuronyltransferase. In Meulengracht’s disease, this process is slowed down and an overdose of ibuprofen may occur. In general, relatively high doses of ibuprofen are required for a poisoning with ibuprofen, which are not so easily achieved, which is why taking ibuprofen is considered to be safer than, for example, paracetamol in patients with Meulengracht’s disease.Nevertheless, the intake should be discussed with the doctor, as overdose can cause kidney damage.
As a precaution, patients with Meulengracht’s disease should not take paracetamol, as a poisonous intermediate product may accumulate due to insufficient metabolism with UDP-glucuronyltransferase. Above a certain concentration, the toxin can no longer be excreted and binds to liver cell proteins, causing irreversible liver damage and ultimately leading to liver failure. Estradiol and ethinylestradiol, the estrogen components of oral contraceptives (“pill”), are also broken down by the affected enzyme UDP-glucuronyltransferase. As a result, the pill is broken down more slowly in Meulengracht’s disease. However, the estrogen concentration of the preparations on the market today is relatively low, which is why they can be taken after consultation with the treating gynaecologist.
What is the best diet for Meulengracht’s disease?
In general, people with Meulengracht’s disease can eat a completely normal diet and only have to pay attention to a few things. Longer periods of hunger or fasting cause the bilirubin concentration in the blood to rise and the symptoms of Meulengracht’s disease to worsen. For this reason, patients must ensure that they eat sufficient and regular food.
Even if morning sickness is caused by pregnancy, affected pregnant women must remember that despite vomiting, they consume sufficient calories and thus do not provoke a surge of symptoms. Patients must also make sure that they eat a balanced and not too one-sided diet, since even low-fat food can cause the bilirubin level to rise. The right diet can have a great effect and have a positive effect on the symptoms of Meulengracht’s disease.
A sufficient intake of water causes the kidneys to work more efficiently and accelerates the detoxification of the body. This can lower the bilirubin concentration in the blood. Fresh fruit and vegetables provide fiber and vitamins that can help against rapid fatigue and flaccidity. Against recurring nausea, freshly brewed peppermint tea or peppermint lozenges can be helpful when you are on the go.
